ANAL FISSURE

DON DAVIS RIEZA

CLARISA REYES
 DEFINITION:
• Longitudinal tear or ulceration in the
anal canal
• cut or tear occurring in the anus
• may develop in adults from passing
hard or large stools during bowel
movements
• also common in infants between 6 and
24 months
• If not promptly diagnosed and treated,
these small tears and their occasionally
associated superficial infection cause
severe anorectal pain during bowel
movements and set in motion a cycle
of stool negativism, constipation, and
increasing pain with subsequent
defecation.
 CAUSE AND ETIOLOGY
• Trauma -passage of hard stool
(constipation)
-anal intercourse
- rectal examination
speculum
• Low-fiber diets- lacking in raw fruits
and vegetables
• Prior anal surgery -scarring from the surgery
may cause either stenosis or tear of the anal
canal. For example hemorrhoidectomy,
fistulotomy.
• Chronic diarrhea/explosive diarrhea
• Perianal dermatitis/ or infection
• Childbirth
• Overuse of laxatives
 ASSESSMENT
PBIV
• Pain or burning during bowel movements
that eases until the next bowel movement
• Bright red blood or Bleeding on the
outside of the stool or on toilet paper or
wipes after a bowel movement
• Itching or irritation around the anus
• A visible crack in the skin around the
anus
• Constipation is also another
symptom characterized by
debilitating condition and
significant exertion and struggle
n eliminating hard feces.
 DIAGNOSTICS
• Gentle inspection of the anus
can confirm the presence of a
fissure. Digital rectal exam.
• Anoscopy
• Endoscopy (if rectal bleeds)
• Sigmoidoscopy
• Colonoscopy
• Upper gastrointestinal
(UGI) and small bowel x-
rays.
• Nursing diagnosis
Acute pain related to
tearing or ulceration in
the lining of the anal
canal.
 MANAGEMENT
• Anal fissures are fairly common and
usually heal without treatment or
with nonsurgical treatments. Signs
and symptoms may go away within
two weeks. If the tear doesn't heal
within six to eight weeks, however,
you may need surgery.
• The goals of treatment are to
relieve the constipation and pain
thus to break the cycle of hard
bowel movement, associated pain,
and worsening constipation and
spasm of internal anal sphincter.
 NURSING INTERVENTIONS
• relieve the constipation and pain
thus to break the cycle of hard
bowel movement, associated
pain, and worsening
constipation and spasm of
internal anal sphincter.
 INDEPENDENT
• adding more fiber to your diet
• drinking more water
• getting regular exercise
• taking a stool softener or occasional
laxative
• (sitz bath) for 20 minutes 2 or 3 times a
day
 PHARMACOLOGY
• Medicated creams or suppositories:
doctor may prescribe a rectal
corticosteroid (Anusol, others) or
recommend an over-the-counter
cream or ointment containing
hydrocortisone (Cortaid, Preparation
H) to help reduce inflammation and
ease discomfort.
• nitroglycerine ointment to the
anus, which widens blood
vessels and increases blood
flow to the tear, promoting
healing
Nifedipine and Diltiazem
• reducing the pressure in the internal
anal sphincter
Botulinum toxin (Botox)
• causes temporary paralysis of muscle,
which can reduce muscle tension and
help the anal fissure heal.
 SURGICAL INTERVENTION
• Sphincter dilatation
– controlled anal stretch or dilatation under
general anesthetic. This is performed
because one of the causative factors for
anal fissure is thought to be a tight
internal anal sphincter; stretching it helps
correct the underlying abnormality, thus
allowing the fissure to heal.
• lateral internal sphincterotomy
• a small incision is made into
the internal anal sphincter to
reduce anal resting
pressure.
• END